Nurses who stay abreast of the latest maternal-child research recognize that many current practices in labor and delivery are not evidence based. We find nurses who still encourage directed “count-to-ten” pushing for uncomplicated deliveries. Some nurses don’t find or take the time to support early, unsupplemented breastfeeding, even when the mother is motivated and interested. Nurses often don’t support intermittent auscultation, even though the evidence has motivated ACOG and AWHONN to support it as a practice equivalent in efficacy to electronic fetal monitoring for low risk pregnancies and labors. The examples are many.

Frustration can result for nurses who wish to support and initiate evidence based care. The process of re-educating nurses who have already been indoctrinated in a different direction can be very challenging. Physicians often do not support them in their efforts, if the current practices better serve physician interests. How can we change the future for labor and delivery nursing to better support what has been shown to be best for patients? Some of the keys may lie in nursing student education and more effective professional models for students in the clinical setting.

Nursing programs struggle to find time for the “need to know” content, let alone the “nice to know” information. Most programs have treated supportive bedside care and less interventionist practices in labor as “nice to know,” regardless of support for benefits and often overwhelming evidence of potential harm with alternatives. One midwestern U.S. baccalaureate nursing program has changed this focus by guiding students to critically think about the evidence, as well as using models and simulation to build a tool box of supportive skills for students to use in the real world.

Students are provided with lab experiences that allow them to understand the labor process in a hands-on fashion, and to practice basic labor assessment skills as the foundation of their nursing role. But they also learn that positioning, massage and nurturing support are equally important in their roles. They practice skills with peers that help them to feel comfortable in applying them in clinical settings, with preceptor approval. Although some nurses appear to be intimidated by their knowledge and comfort in using it at the bedside, others have expressed, “your students are the best.”

Methods used to stimulate student awareness of and commitment to evidence based practice will be presented. Student directed activities and learning, including peer teaching, will be featured. The benefits of critically thinking nurse graduates entering the work force will be addressed. Suggestions for nurses preceptors to use in expanding nursing student excellence will be shared.